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Wednesday, March 24, 2010

How To (and not) Breast Pump at Work

A friend of mine (anesthesiologist) is expecting her first baby any day now. She had a lot of questions about breast pumps, ie how difficult was it to pump at work? How did you deal with call? What were your colleagues' attitudes towards pumping? What breast pumps would you recommend? How much time does it take to pump (on average)? How long did you breastfeed for, and was your decision to stop influenced by work issues?I did read Fizzy's post a while ago (formula vs breast milk) but my friend and I want to know the details. If you don't feel this would be too repetitive, it would be great to hear what the other mothers in medicine think.Liana

My daughter, Sicily, was a dream baby as far as the pumping goes. I'm paying for it now, in elementary school, but that is the topic of another blog. Pumping was tough to learn, but once my friend Mel showed me the ropes, it was smooth sailing. I had a top of the line Medela - I'm sure there's a newer model out now. It was worth it to me to shell out the bucks for efficiency. All of the books recommend that you pump as often as you would nurse, but when you have a hungry, demanding baby this seems unreasonable. I usually tried to pump twice a day at work. I was on clinical pathology rotations my second year of residency - had adequate time to manage my goals. I studied during the process.

I tried to pump in the pumping station at the hospital near OB, but it was so far away and all of the dried milk spots on the chairs, walls, and floors in the cubicles behind sheeted doors freaked me out. So I used Mel as a mentor again and pumped in an empty apheresis room - nice and clean. And I'm nice and clean so it worked out for the apheresis attending. I usually pumped at 10:00 and 2:00 - it took about thirty minutes start to finish, including rinsing out the parts and storing the milk. Toward the end I was able to back off to once a day when my production started waning. There was one unfortunate incident of a male nurse walking in on me while I was pumping - it was embarrassing at the time but funny in retrospect - he couldn't look me in the eye for weeks. I think he was more embarrassed than I was.

I was a cow as far as production goes - I remember once falling to pieces when the power went out on a weekend when I was alone at home. I called the poor Entergy company assistant in tears.
"When is the power coming back on? I have all of my milk in the freezer! If it thaws, I will have to throw it away. Are you sure they are fixing it? Can you please tell me again the exact time you expect it to come back on?"

When you work that hard, a tiny bag of frozen milk is like liquid gold.

I pumped/nursed for eleven months with Sicily. It was just time to quit - we both seemed to know it. It was a very smooth transition to frozen milk, and she was on formula by a year.

When I had my son two years and four months later, I thought I was living my dream. Perfect marriage, doctor husband, girl and boy, and well on my way to (in my opinion, and many others, some will beg to differ - there are a lot of great jobs in this state) the best job in the state. I was going to work at the hospital my dad and husband worked at. Plans don't always work out the way you want them to, but this isn't always a bad thing.

At the time, things were going according to my plan. But with my son John, things degenerated. He didn't sleep all night at three months like my daughter - he wanted to nurse three times a night. Hard to blame him - he didn't get much of me during the day - but it was killing me. I was also on some tougher rotations, so I reduced pumping to once a day. I would nurse in the wee hours of the morning, pump again after getting ready before I went to work, and suck it up until around noon, when my breasts were like lead balloons. Well, not really lead - they were a little more lumpy. Think a million tiny shrubs under your skin, full to bursting point. I had to get a third storage bottle - I was going way over 12 ounces. I didn't have time to go down to the apheresis unit on the first floor. I just ate a quick stash of processed food for lunch, and made fast friends with the residency coordinator/mom, who let me pump in her office. I could squeeze it in (or out!) in twenty minutes, now. I was a little more rushed overall, at that time in my life.

I sat on the residency coordinator's floor with my face to the wall. Sometimes she left. Sometimes she stayed, and we chatted about kids, life, and family. I really enjoyed that - it was one of the highlights of my day. Female bonding.

This style of pumping was OK for John, but not for me. I had a lot more problems with dehydration and blocked ducts. I've got a pretty high pain tolerance, but blocked ducts have to be one of the most painful experiences on the planet. Worse than childbirth (well, I did have epidurals, so that is not a fair comparison). When he was around seven or eight months, in early winter, I let him cry it out at night, and stopped nursing. This was a much more painful emotional experience because A) We weren't ready B) I was exhausted and had to start studying for my Anatomic Pathology/Clinical Pathology boards in June and C) I was beyond sad and depressed and strung out and D) I knew this would probably be my last time to nurse. It was an amazing experience overall, and I couldn't see myself ever doing it again. I was going to miss it. Luckily, I have nursing dreams to remember the rush of relaxing hormones that accompanied contraction and let-down. I am not talking about pumping here, I'm talking about the real thing.

I wish I could speak to the call, but we pathologists get a break, on the call. So hopefully someone will comment on that in the comment thread. Colleagues attitudes - I am sure I occasionally annoyed, but this was usually temporary, situational, and not always my fault. It is tough to control other people's moods, and sometimes they will project their frustrations onto anything. I did have to get coverage some days, especially with John, when I was responsible for junior residents or covering frozens. People ask to be covered for a lot of reasons, and this was one of the few I asked, so I tried not feel too guilty when others worked for me and made sure to do extra favors when I was around. I like to think that overall I was admired tremendously by residents and attendings. I'll bet if I took a survey the results would back up my hunches.

I am proud of all of my efforts and work, even though it got a little crazy, single-minded, and self-sacrificing at the end. I beat myself up way too much for giving Sicily that extra few months - I felt like John needed it more, since he was six weeks premature. But he is a happy, healthy, well-adjusted four and a half year old, so I think I did all right by them both, in hindsight.

11 comments:

Some tips for making it work:-talk to the lactation consultants in your hospital- they helped me discover pumping rooms (some with fridges) all across the hospital campus-get a pumping band (I had the made by moms brand from diapers.com) that way you can go handless and study or if you still have paper notes, do these during pumping...or though it may make some shudder, even pump while driving if you have any sort of commute-I always thought of breast milk/nursing as the one thing I could do for my baby that no one else could, so that on those call nights or just long days when I wouldn't see him awake I had something to hold on to that made me feel a little less guilty about being a working mom-if there are no pumps available for you to use at the hospital (such as one in the NICU or somewhere else in the hospital) consider buying a cheap pump to have at home and leaving a nice one in a locker at work so you don't have to lug the pump back and forth every day-do everything humanly possible to make pumping as easy as imaginable for you...as stated in the post, buy the more expensive dual pump-do your research on what pumping facilities are available, how you will cover your patients while you are pumping, etc BEFORE you return to work, not on your first day back-give yourself a break, while we have all learned the physiologic and emotional benefits of breastfeeding for both moms and babies, know that your child will be happiest and healthiest when you are happiest and healthiest and if pumping is making you miserable, it's not worth it. You may be able to continue with just one or two feedings a day even if you can't pump throughout the day.

Great post, Gizabeth! I went through pumping twice, once as a resident (daughter, CindyLou), once as a solo-practitioner (son, Bean).

Both times I purchased a new Medela "Pump in Style." Backpack style 1st go around, messenger bag style 2nd go around. (Oh, the exorbitant extravagance, I know, but when I got my old pump out of storage to clean up the second time around, it was, erm, moldy. Hence, brand new pump.) They were easy to take back and forth to work, came with a snazzy little milk cooler and freeze pack with little niches carved out for the bottles, and wonderfully efficient. With the dual pump I could be done pumping in 15-20 minutes, easily. Even nicer, I could always get extra pump parts from L&D storage because our hospital grade pumps were also Medela...not to mention the great line of products they have. (Swear I am not a spokesperson, but would love to be! Medela, if you are out there, call me!!)

Bean: Thirteen months...he would have nursed forever, I think, but we phased it out gently.

How difficult was it to pump at work?

CindyLou: Difficult, but usually manageable. I would pump in the on-call room, aiming to pump every three to four hours. Sometimes, surgery or L&D would get hairy and I would get the "torpedo effect" as Gizabeth so beautifully describes above. I cannot tell you the physcial *relief* it is to pump after going so long!

Bean: Moderately easier. I would nurse before I left the house, go round, pump in my office before morning patients, at lunch time, and around 3 pm (that session was the first to go, as my office staff could never manage to block a 30 minute window of time). When I got to go home (no labor pts.) I would either nurse Bean when I got home or pump if he had been fed recently.

How did you deal with call?

Much the same way. I brought the pump with me, brought extra bottles, kept the microwavable steam bags (so awesome) in the pump bag, and kept my labeled bottles in the "milk fridge" on L&D (a nice commodity to have). I would pump every 3-4 hours and try to mimic my night-time feeding schedule as closely as I possibly could.

On L&D, we actually had so many nurses and staff nursing and pumping at the same time, we would designate a particular L&D room for "Fred" (the floor hospital grade pump) and any of us that wanted to would store our pumping things in that room and use it while on L&D.

I actually missed a delivery once when I checked a pt, (4cm dilated), went into the empty room 2 doors down, and got halfway through my 20 min session and got paged overhead. Pt. had precipitously delivered in the bed, even the nurse missed it. Multips.

How were your colleagues' attitudes towards pumping?"

Luckily, in OB/GYN, pretty darn supportive. It really rarely took more than 20 minutes at any given stretch, so it wasn't like I was forever slacking on the work or anything. I more or less treated it like a really long bathroom break. It simply had to be done. I don't recall getting any flack...except for my office staff, who could not, for the life of them, remember to block 30 minutes in the 3 o'clock hour for me to pump (ok, so maybe I am bitter about this and need to let it go??)

Anonymous - great extra tips. I didn't know about the pumping band, and was jealous after I was done when a friend described it to me. I held onto those funnels for months.

And I forgot about that feeling of "being there" by pumping when you can't be. I had that, too, and it kept me going. Well put!

KC - I wrote down your reference and can't wait to check it out. Love the title - "Paying at the Pump."

Dr. Whoo - Thanks for adding your experience! Sounds a little more balanced than mine. I had the Pump In Style backpack - you reminded me of the model name. So stylish - carrying around that milk-spattered backpack. I remember leaving it places and having that gut-dropping sensation upon realization - it was like a third arm for so long.

How long did you breastfeed? Four months, two months at work. I wished I could have gone longer. My milk dried up, it broke my heart. I just could not get it together. Too busy during the day to pump, did not drink enough water. I was probably not eating enough too, in retrospect

How difficult was it to pump at work?My hospital has a rental program where I was able to keep a hospital grade pump in my office. I then had a standard model at home.

Having an office with a door that locks was very helpful. For those of you who are faculty members, think about helping your trainees find safe comfortable place. Chances are they will not ask for special arrangemetns to be made for them.

How did you deal with call?Lucky me as an attending this was from home.

How were your colleagues' attitudes towards pumping?It never came up, which is funny as I was constantly thinking obout it all day.

Additional tip- my best friend showed me how you can tuck the pump shield into your nursing bra (if left fastened) and go hands free without a band. I found this worked only with bras without underwire.

These are all such great tips. A few more to add - I have a 16 month old son and work full-time in academic primary care. Pumped through 12 months - it was so tough but glad I did it.

-Make sure you introduce one bottle of pumped milk a day at around 3 weeks (this will help baby accept bottle and still take the breast). A colleague/friend of mine did this then slacked off right before she went back to work from 3 months of maternity leave - didn't do the bottle for a week. She went back to work and her daughter wouldn't take the bottle!

-Make sure you talk to someone in your specific field of medicine. I imagine anesthesiology has some unique challenges, since surgical cases are of variable length and it may take some specific planning to get a break to go pump.

-Agree with the pump "bra," I was able to type while pumping (though part of me wished I didn't have this option and could have just zoned out).

-Just from talking to people and from my own experience, if you really want to keep your milk production up, it's a good idea to pump 3 times a day at least until 6 months. However don't feel badly if this isn't possible, just realize you will probably be supplementing with formula (which is not a failure in any way! Just something to be prepared for).

Thanks for the extra tips, anonymous! I love how you added in a rational number of pumping per day - with my daughter I did 4/day during peak production and with my son averaged 3/day. Those are important numbers for moms to know - so they can work it in with their various schedules (and their baby's needs).

I love seeing all the peer to peer support and advice! When I was a midwifery student, my favorite class was the lactation class. Many of the women in the room had breastfed, and it was so cool hearing each other's stories and descriptions. Someday, have eight different women try to describe what milk letdown sounds like.

I pumped at two different jobs, although I was still a premed at the time. It can be done, but it takes a little juggling and cooperation. I felt so bad for a nurse I saw at my school's clinic who was pumping in the public bathroom right out by the sinks. I told her I was so happy to see her pumping, and I guess she is setting a good example, but I would feel self-conscious in that situation. Finding a nice room, hopefully with a little privacy, can be really key.

I don't think this was mentioned, so I have one more piece of advice. I didn't have a real problem with supply (thankfully!), but a pump can take some getting used to. I found it helpful to bring a picture of my baby with me, and look at it, or to imagine breastfeeding. It made it easier to get to the letdown reflex, and that can make pumping more comfortable and effective.

I wish I could have heard those eight descriptions of letdown. I am still struggling with the right words, myself.

Thanks for the extra tips, MomTFH. I love reading your posts. You are an inspiration to me - it is amazing to read about someone brave enough to pursue their dreams and not get hung up on worrying about being an impediment to their family's happiness. Your happiness is their happiness, and it is clear that you are on the right path. I'll bet your family is achingly proud of you.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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